Healthcare Provider Details

I. General information

NPI: 1245840792
Provider Name (Legal Business Name): SARAH A WYNNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2020
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 S MERIDIAN RD
YOUNGSTOWN OH
44509-2925
US

IV. Provider business mailing address

238 S MERIDIAN RD
YOUNGSTOWN OH
44509-2925
US

V. Phone/Fax

Practice location:
  • Phone: 330-318-3436
  • Fax:
Mailing address:
  • Phone: 330-318-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: